Smallpox Vaccination to Be Available to All

President Bush, citing “the current level of threat and the inherent health risks” of the smallpox vaccine, said Friday that he will take the vaccine but neither his family nor his staff would be inoculated against the deadly disease, even as he made the vaccine available to all Americans for the first time in 30 years.

“At present, the responsible course is to make careful and thorough preparations in case a broader vaccination program should become necessary in the future,” Bush said. “There may be some citizens, however, who insist on being vaccinated now. Our public health agencies will work to accommodate them.

“But that is not our recommendation at this time.”

Bush ordered the vaccination of as many as 500,000 military personnel and announced that he, as commander in chief, would also be inoculated. And he rolled out a plan for the voluntary inoculation of some 439,000 public health workers and emergency room doctors and nurses who would be among the first to investigate and treat victims of a smallpox outbreak.

By making the vaccine available to all Americans without encouraging them to get it, Bush placed his administration’s long-awaited smallpox vaccination policy squarely in the context of other protective steps the country has taken since the Sept. 11 terrorist attacks. He did not present the policy as a response to real or perceived threats.

“We know that the smallpox virus still exists in laboratories. And we believe that regimes hostile to the United States may possess this dangerous virus,” he said.

“Our government has no information that a smallpox attack is imminent,” he added. “Yet it is prudent to prepare for the possibility that terrorists who kill indiscriminately would use diseases as a weapon.”

Tom Ridge, nominee for secretary of the new Homeland Security Department, said, “We inoculate in order to prevent” a possible attack using the smallpox virus, which can kill as many as one third of its victims.

Bush and his administration’s top homeland security and public health officials also took care to emphasize that the government has enough doses of the vaccine, as well as a rough state-by-state plan, to inoculate all Americans in the event of a bioterror attack using the virus.

“We know how to fight smallpox,” said Dr. Julie L. Gerberding, director of the national Centers for Disease Control and Prevention. “We have wiped out this disease before.”

The administration’s top priority, the officials said, is the vaccination of front-line military troops and diplomatic personnel, particularly those stationed in the Middle East, and the essential medical personnel who would be called upon to treat smallpox victims and to vaccinate other Americans.

Implementation of the Pentagon’s vaccination plan began Friday at Walter Reed Army Medical Center, where a few dozen military “first responders” were inoculated, said Dr. Bill Winkenwerder, assistant secretary of Defense for health affairs.

It was unclear when the president would be vaccinated. Ridge said Bush would make that decision with the help of the White House physician.

The vaccination of members of the emergency response teams is unlikely to begin until late January, when states and cities have had the time to set up vaccination clinics, and the liability provisions in the law establishing the Homeland Security Department have taken effect.

The CDC has encouraged states to complete their vaccination of response team members within 30 days, but Gerberding acknowledged Friday that some states will need longer.

Once that round of vaccinations is complete, state and local health agencies will begin vaccinating as many as 7 million other health-care and hospital workers, along with police, fire and other emergency personnel.

People who have eczema, a history of atopic dermatitis or HIV, as well as organ transplant patients, those being treated for cancer and pregnant women, should not volunteer to receive the smallpox vaccine, health officials said.

Health and Human Services Secretary Tommy G. Thompson acknowledged that many concerns health workers have about both getting and giving the vaccine -- including paid time off to recover from any harmful side-effects of the vaccine and protection from being sued by those harmed by the vaccine -- remained unresolved Friday.

“We are doing everything we can to make Section 304 protect as many people as possible,” he said, referring to the Homeland Security provision that exempts manufacturers of the vaccine from lawsuits.

Bush and the officials also stressed possible health complications that can be caused by the vaccine, which contains a live virus closely related to the smallpox virus called vaccinia.

Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, cited a 1968 study showing that from 14 to 52 of every million people vaccinated for smallpox could experience life-threatening side effects. They include encephalitis, an inflammation of the brain, and progressive vaccinia, a condition that destroys skin tissue. One or two of those people would probably die.

Another 49 to 935 of every million people vaccinated are likely to experience less serious side effects, such as muscle aches, fever and fatigue, Fauci said.

Sometime next spring or summer, unlicensed stocks of the vaccine will be made available to the general public. Thompson said he was not aware of a large demand for vaccinations, and all the officials reiterated that they were not recommending mass vaccinations at this time.

“But we will ensure access,” Gerberding said.

She suggested that Americans most anxious to get the vaccine enroll in a clinical trial. Others should wait for the creation of a new, broader vaccine protocol or until additional doses of the licensed vaccine become available in 2004, she said.

The vaccination plan represents 15 months of planning and preparation by several federal agencies, all 50 states, four cities, and some 3,300 hospitals and other health-care facilities.

“Protecting our citizens from this deadly disease is definitely worth the effort we’re asking from our cities and states,” Thompson said.

Ultimately, Thompson added, the planning will strengthen the same public health system that must respond to far more common health threats, including influenza, listeria and the West Nile virus.

Thompson encouraged Americans with questions about the vaccination to consult the government’s new Web site, www.smallpox.gov.